Americans are dying at a shockingly high rate from preventable causes, found a first-of-its-kind global health study published late Thursday.

The new research demonstrates that despite the fact that the U.S. has the largest economy in the world, healthcare for many of its residents is woefully inadequate. The U.S. was tied with Estonia and Montenegro, far below other wealthy nations such as Norway, Canada, and Australia, in the study’s ranking of 195 countries.

“America’s ranking is an embarrassment, especially considering the U.S. spends more than $9,000 per person on health care annually, more than any other country,” said Dr. Christopher Murray, senior author of the study and director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “Anyone with a stake in the current healthcare debate, including elected officials at the federal, state, and local levels, should take a look at where the U.S. is falling short.”

The study published in the Lancet created a Healthcare Access and Quality (HAQ) Index, “a summary measure based on 32 causes, that in the presence of high-quality healthcare, should not result in death,” the researchers wrote.

“Using deaths that could be avoided as a measure of the quality of a health system is not new but what makes this study so important is its scope, drawing on the vast data resources assembled by the Global Burden of Disease team to go beyond earlier work in rich countries to cover the entire world in great detail, as well as the development of a means to assess what a country should be able to achieve,” said Professor Martin McKee of the London School of Hygiene & Tropical Medicine, who participated in the study.

“The United States measures well for diseases preventable by vaccines, such as diphtheria and measles, but it gets almost failing grades for nine other conditions that can lead to death,” reported the Washington Post. “These are lower respiratory infections, neonatal disorders, non-melanoma skin cancer, Hodgkin’s lymphoma, ischemic heart disease, hypertensive heart disease, diabetes, chronic kidney disease, and the adverse effects of medical treatment itself.”

“What we have found about healthcare access and quality is disturbing,” said Dr. Murray. “Having a strong economy does not guarantee good healthcare. Having great medical technology doesn’t either. We know this because people are not getting the care that should be expected for diseases with established treatments.”

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With neither its farmers nor fishermen safe from Saudi coalition attacks, famine has become a massive crisis in Yemen, further exacerbated by the coalition’s blockade of the country which largely prevents food from being imported into the troubled nation.